How do surgery and balloon angioplasty compare in the repair of coarctation of the aorta (CoA)?

Updated: Nov 20, 2018
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

Scant data are available to compare surgical intervention with balloon angioplasty. In an attempt to compare the safety and efficacy of balloon angioplasty with surgical correction of aortic coarctation, the authors scrutinized 49 papers (published from 1980-1991) that reported on results of surgery in infants younger than 1 year and 9 papers that compared the results of balloon angioplasty in children. [37, 48] These data showed that recoarctation rates are similar, whereas the mortality rates are slightly higher in the surgical than the balloon angioplasty series. Similar comparison of results in children older than 1 year showed identical results.

Shaddy and associates (1993) prospectively randomized 36 patients aged 3-10 years to undergo either balloon angioplasty (20 patients) or surgery (16 patients) and found similar immediate pressure gradient relief in both groups. [75] The risks of aneurysm formation and restenosis were higher in the balloon angioplasty group, whereas risks of neurologic complications were higher in the surgical group. They concluded that balloon angioplasty in coarctation of the aorta may provide an effective initial alternative to surgery in children beyond infancy and suggested that further follow-up is needed to evaluate the long-term risks of aneurysms following angioplasty.

The senior author compared the efficacy and safety of balloon angioplasty with those of surgical correction in infants younger than 3 months. [38] Data on 29 infants who underwent intervention for aortic coarctation from 1982-1992 were examined. Fourteen infants underwent surgical repair, and 15 underwent balloon angioplasty. The data indicated that the degree of relief of aortic obstruction and the frequency with which reintervention is needed are similar in both groups. However, balloon angioplasty carries lower morbidity rates and complications than with surgical therapy. Based on these data, the we suggested that balloon angioplasty may be an acceptable alternative to surgery in the treatment of symptomatic aortic coarctation in infants younger than 3 months.

Shim and colleagues (1997) compared hospital charges and found lower charges for patients who underwent balloon therapy compared to surgery. [76]


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